Electroconvulsive therapy in geriatric patients: A literature review and program report from Virginia Commonwealth University, Richmond, Virginia, USA

Electroconvulsive therapy (ECT) is an effective therapeutic intervention in the elderly patients with major depression, especially those with psychosis, suicidality, catatonia, nutritional compromise, and resistance to medications. Response rates can be as high as 80%. We present an extensive review of the relevant literature, provide a description of the ECT program at Virginia Commonwealth University in Richmond, Virginia, USA, and present results of our experience with ECT in fifty elderly patients. The treatments were safe, well tolerated, and produced high response rates, variably between 68% and 84%. Patients in the long‑term maintenance ECT program continue to show sustained benefits from ECT

Evaluation of Overlay/underlay Waveform via SD-SMSE Framework for Enhancing Spectrum Efficiency

Recent studies have suggested that spectrum congestion is mainly due to the inefficient use of spectrum rather than its unavailability. Dynamic Spectrum Access (DSA) and Cognitive Radio (CR) are two terminologies which are used in the context of improved spectrum efficiency and usage. The DSA concept has been around for quite some time while the advent of CR has created a paradigm shift in wireless communications and instigated a change in FCC policy towards spectrum regulations. DSA can be broadly categorized as using a 1) Dynamic Exclusive Use Model, 2) Spectrum Commons or Open sharing model or 3) Hierarchical Access model. The hierarchical access model envisions primary licensed bands, to be opened up for secondary users, while inducing a minimum acceptable interference to primary users. Spectrum overlay and spectrum underlay technologies fall within the hierarchical model, and allow primary and secondary users to coexist while improving spectrum efficiency. Spectrum overlay in conjunction with the present CR model considers only the unused (white) spectral regions while in spectrum underlay the underused (gray) spectral regions are utilized. The underlay approach is similar to ultra wide band (UWB) and spread spectrum (SS) techniques utilize much wider spectrum and operate below the noise floor of primary users. Software defined radio (SDR) is considered a key CR enabling technology. Spectrally modulated, Spectrally encoded (SMSE) multi-carrier signals such as Orthogonal Frequency Domain Multiplexing (OFDM) and Multi-carrier Code Division Multiple Access (MCCDMA) are hailed as candidate CR waveforms. The SMSE structure supports and is well-suited for SDR based CR applications. This work began by developing a general soft decision (SD) CR framework, based on a previously developed SMSE framework that combines benefits of both the overlay and underlay techniques to improve spectrum efficiency and maximizing the channel capacity. The resultant SD-SMSE framework provides a user with considerable flexibility to choose overlay, underlay or hybrid overlay/underlay waveform depending on the scenario, situation or need. Overlay/Underlay SD-SMSE framework flexibility is demonstrated by applying it to a family of SMSE modulated signals such as OFDM, MCCDMA, Carrier Interferometry (CI) MCCDMA and Transform Domain Communication System (TDCS). Based on simulation results, a performance analysis of Overlay, Underlay and hybrid Overlay/Underlay waveforms are presented. Finally, the benefits of combining overlay/underlay techniques to improve spectrum efficiency and maximize channel capacity are addressed

Enteral lactoferrin supplementation for very preterm infants: a randomised placebo-controlled trial

Background Infections acquired in hospital are an important cause of morbidity and mortality in very preterm infants. Several small trials have suggested that supplementing the enteral diet of very preterm infants with lactoferrin, an antimicrobial protein processed from cow's milk, prevents infections and associated complications. The aim of this large randomised controlled trial was to collect data to enhance the validity and applicability of the evidence from previous trials to inform practice. Methods In this randomised placebo-controlled trial, we recruited very preterm infants born before 32 weeks' gestation in 37 UK hospitals and younger than 72 h at randomisation. Exclusion criteria were presence of a severe congenital anomaly, anticipated enteral fasting for longer than 14 days, or no realistic prospect of survival. Eligible infants were randomly assigned (1:1) to receive either enteral bovine lactoferrin (150 mg/kg per day; maximum 300 mg/day; lactoferrin group) or sucrose (same dose; control group) once daily until 34 weeks' postmenstrual age. Web-based randomisation minimised for recruitment site, gestation (completed weeks), sex, and single versus multifetal pregnancy. Parents, caregivers, and outcome assessors were unaware of group assignment. The primary outcome was microbiologically confirmed or clinically suspected late-onset infection (occurring >72 h after birth), which was assessed in all participants for whom primary outcome data was available by calculating the relative risk ratio with 95% CI between the two groups. The trial is registered with the International Standard Randomised Controlled Trial Number 88261002. Findings We recruited 2203 participants between May 7, 2014, and Sept 28, 2017, of whom 1099 were assigned to the lactoferrin group and 1104 to the control group. Four infants had consent withdrawn or unconfirmed, leaving 1098 infants in the lactoferrin group and 1101 in the sucrose group. Primary outcome data for 2182 infants (1093 [99·5%] of 1098 in the lactoferrin group and 1089 [99·0] of 1101 in the control group) were available for inclusion in the modified intention-to-treat analyses. 316 (29%) of 1093 infants in the intervention group acquired a late-onset infection versus 334 (31%) of 1089 in the control group. The risk ratio adjusted for minimisation factors was 0·95 (95% CI 0·86–1·04; p=0·233). During the trial there were 16 serious adverse events for infants in the lactoferrin group and 10 for infants in the control group. Two events in the lactoferrin group (one case of blood in stool and one death after intestinal perforation) were assessed as being possibly related to the trial intervention. Interpretation Enteral supplementation with bovine lactoferrin does not reduce the risk of late-onset infection in very preterm infants. These data do not support its routine use to prevent late-onset infection and associated morbidity or mortality in very preterm infants. Funding UK National Institute for Health Research Health Technology Assessment programme (10/57/49)

A bioanalytical method development and validation for quantification of glycopyrrolate and neostigmine in rat plasma by LC-MS and its application to pharmacokinetic study

Background: After surgery, non-depolarizing neuromuscular blocking medications include neostigmine (NEO) and glycopyrrolate (GLY). Numerous traditional approaches, such as HPLC and UPLC procedures, are established for the quantification of GLY and NEO; nevertheless, they lack sensitive and specific analysis, especially in complex matrices.  Using the LC/MS approach, this work develops a bioanalytical method for quantifying both drugs in rat plasma and applies it to pharmacokinetic studies. Methodology: The plasma was extracted using acetonitrile, and Rivastigmine was employed as an internal standard. An MRM method with positive ions was used for multiple reactions. A  C18 column and a mobile phase - 70:30 mixture of acetonitrile and buffer was utilised at a flow rate of 1 ml/min. Plasma vortex for 10 minutes and centrifuged at 4000 rpm at 20°C. Validation and stability studies are conducted according to the ICH guidelines. The pharmacokinetic study by WinNonlin (Version 5.2) software.  Results and Discussion: Rt for Glycopyrrolate and Neostigmine at 1.838 and 2.800min. GLY has a precision (%CV) of 0.45 at HQC and 3.57 at LQC. NEO had a precision (%CV) of 1.13 at HQC and 2.79 at LQC. From 2 to 40 ng/mL of GLY and 10 to 200 ng/mL of NEO, the standard curves showed a linear relationship. LOD and LOQ for both drugs were 3pg/mL and 10pg/mL. Conclusion: A simple, affordable, reliable, and sensitive approach for quantifying GLY and NEO in rat plasma using LC-MS, with Rivastigmine serving as the internal standard, was developed, validated, and successfully applied in the pharmacokinetic study of rat plasma

Anaerobic Carbon Monoxide Dehydrogenase Diversity in the Homoacetogenic Hindgut Microbial Communities of Lower Termites and the Wood Roach

Anaerobic carbon monoxide dehydrogenase (CODH) is a key enzyme in the Wood-Ljungdahl (acetyl-CoA) pathway for acetogenesis performed by homoacetogenic bacteria. Acetate generated by gut bacteria via the acetyl-CoA pathway provides considerable nutrition to wood-feeding dictyopteran insects making CODH important to the obligate mutualism occurring between termites and their hindgut microbiota. To investigate CODH diversity in insect gut communities, we developed the first degenerate primers designed to amplify cooS genes, which encode the catalytic (β) subunit of anaerobic CODH enzyme complexes. These primers target over 68 million combinations of potential forward and reverse cooS primer-binding sequences. We used the primers to identify cooS genes in bacterial isolates from the hindgut of a phylogenetically lower termite and to sample cooS diversity present in a variety of insect hindgut microbial communities including those of three phylogenetically-lower termites, Zootermopsis nevadensis, Reticulitermes hesperus, and Incisitermes minor, a wood-feeding cockroach, Cryptocercus punctulatus, and an omnivorous cockroach, Periplaneta americana. In total, we sequenced and analyzed 151 different cooS genes. These genes encode proteins that group within one of three highly divergent CODH phylogenetic clades. Each insect gut community contained CODH variants from all three of these clades. The patterns of CODH diversity in these communities likely reflect differences in enzyme or physiological function, and suggest that a diversity of microbial species participate in homoacetogenesis in these communities

Pandemic governance: Developing a politics of informality.

South Africa had the privilege of learning from how other countries responded to the crisis engendered by the COVID-19 pandemic. However, this opportunity seems to have been lost as the South African government made the mistake of transposing a developed-world preventive response onto a largely developing-world populace. The government failed to map out how factors such as South Africa’s demographic composition, spatial architecture, the incidence of poverty and informality, and competing epidemics would interact synergistically and shape epidemiological outcomes. In this article shaped by sociological insights, we show how the application of governance systems can give rise to many unintended social consequences when the knowledge forms upon which they are based are not suitably tailored to meet the needs of the specific local context. We highlight how informality can play a valuable role in fighting the COVID crisis and suggest that, to truly succeed, the government should include rather than override informal principles of governance.Significance:We present a brief comparative analysis of the responses of different nation states to the COVID-19 pandemic. The insights contribute to the sociological literature as well as to other disciplines, highlighting how local contextual factors are (re)shaping the form of policy responses as well as their associated consequences. More specifically, we focus on the importance of adopting a political economy approach in the analysis of informality and motivate how and why this may be useful for consideration in areas related to policy development and governance more broadly

Peat Bog Wildfire Smoke Exposure in Rural North Carolina Is Associated with Cardiopulmonary Emergency Department Visits Assessed through Syndromic Surveillance

Background: In June 2008, burning peat deposits produced haze and air pollution far in excess of National Ambient Air Quality Standards, encroaching on rural communities of eastern North Carolina. Although the association of mortality and morbidity with exposure to urban air pollution is well established, the health effects associated with exposure to wildfire emissions are less well understood. Objective: We investigated the effects of exposure on cardiorespiratory outcomes in the population affected by the fire. Methods: We performed a population-based study using emergency department (ED) visits reported through the syndromic surveillance program NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool). We used aerosol optical depth measured by a satellite to determine a high-exposure window and distinguish counties most impacted by the dense smoke plume from surrounding referent counties. Poisson log-linear regression with a 5-day distributed lag was used to estimate changes in the cumulative relative risk (RR). Results: In the exposed counties, significant increases in cumulative RR for asthma [1.65 (95% confidence interval, 1.25–2.1)], chronic obstructive pulmonary disease [1.73 (1.06–2.83)], and pneumonia and acute bronchitis [1.59 (1.07–2.34)] were observed. ED visits associated with cardiopulmonary symptoms [1.23 (1.06–1.43)] and heart failure [1.37 (1.01–1.85)] were also significantly increased. Conclusions: Satellite data and syndromic surveillance were combined to assess the health impacts of wildfire smoke in rural counties with sparse air-quality monitoring. This is the first study to demonstrate both respiratory and cardiac effects after brief exposure to peat wildfire smoke